Gastrointestinal Bleeding In Infants Research Articles

Studies on iron metabolism: V. Further observations on cow's milk-induced gastrointestinal bleeding in infants with iron-deficiency anemia

By means of a sensitive radioisotopic, technique and alternating periods of controlled diet, 17 of 34 infants with iron-deficiency anemia were shown to have abnormal occult gastrointestinal blood loss which was induced by whole cow's milk (WCM), commonly associated with hypoproteinemia, and was ameliorated or, stopped by substitution of soya or proprietary milk formulas for the cow's milk feeding. In eight subjects the WCM-induced bleeding did not diminish despite iron therapy so long as WCM was ingested. Limited studies directly implicated bovine serum protein as a probable inciting agent and also demonstrated a correlation between the amount of milk ingested and the degree of bleeding. Follow-up studies on four of the subjects with previous WCM-induced bleeding suggest that the phenomenon may be transient, occurring in infancy, and likely related to development of gastrointestinal immunity. The relative incidence of such WCM-related hemorrhage has not been established, but in our over-all experience it appears to occur in approximately half of young children with iron-deficiency anemia who are ingesting a quart or more of homogenized-pasteurized cow's milk daily.

The detection of occult gastrointestinal bleeding in infants with iron deficiency anemia (IDA)

The detection of occult gastrointestinal bleeding in infants with iron deficiency anemia (IDA)

Further observations on the phenomenon of milk-induced, occult, gastrointestinal bleeding in infants with iron deficiency anemia (IDA)

Further observations on the phenomenon of milk-induced, occult, gastrointestinal bleeding in infants with iron deficiency anemia (IDA)

MILK-INDUCED GASTROINTESTINAL BLEEDING IN INFANTS WITH HYPOCHROMIC MICROCYTIC ANEMIA.

SEVERAL FACTORS are known to contribute to the development of hypochromic microcytic anemia in infants, eg, prematurity, multiple births, and inadequate dietary iron. Recently attention has focused on the possible etiological role of occult gastrointestinal bleeding in certain infants. Although a greater fecal blood loss has been demonstrated in infants with hypochromic microcytic anemia than in controls, using radioisotopic techniques, the cause of this phenomenon has not been elucidated. 1,2 On the basis of previous studies 3 which demonstrated a high incidence of positive guaiac tests on stools, increased concentrations of plasma proteins in gastric juice, and multiple precipitins in high titer to whole cow's milk, it was postulated that the ingestion of whole cow's milk could be responsible for these signs of gastrointestinal dysfunction. It was further speculated that a mechanism of milk-induced gastrointestinal blood loss might lead to hypochromic microcytic anemia in some subjects. The present study was

Bleeding lesions of the gastrointestinal tract in infants and children.

Bleeding from the alimentary tract is an important manifestation of significant disease in all age groups but particularly so in infants and children. Although the astute pediatrician often is able to suggest accurately the source of the blood as a result of careful evaluation of history and physical findings, the roentgen examination is of great value in providing information concerning the exact location and appearance of any lesion. The roentgenologist, therefore, is directly concerned with the causes of gastrointestinal bleeding in infants and children and the relative frequency of lesions producing it. The incidence of disease differs not only between adults and children but in children of various ages from birth to fifteen years. Conditions occur in infancy that are not seen in older children and adults. In order to classify the causes of bleeding from the alimentary tract, we first reviewed the case records and roentgenograms of all infants and children seen at the Mayo Clinic in a five-year period with gastrointestinal conditions that might cause gross bleeding. Our findings indicate that bleeding is a fairly common sign of gastrointestinal disease in children, being present in approximately 50 per cent of the series reviewed. This percentage, however, is undoubtedly high, since the cases selected for study were those in which bleeding was thought likely to occur. The 246 cases in which bleeding from the gastrointestinal tract was encountered form the basis of this report. All cases of bleeding from hemorrhoids, anal fissure and anal abrasion, as well as from the mouth and nose, were excluded. Since this report deals only with those cases in which gross blood was present, cases of anemia due to occult bleeding were also excluded. This selection seemed necessary because anemia is so often due to disease not directly involving the gastrointestinal tract. Causes of Bleeding The causes of bleeding from the gastrointestinal tract in this group of 246 cases are listed in Table I. The most common cause of bleeding in infants and children in our experience is chronic ulcerative colitis. This condition and polyps of the colon, which are next in importance, were responsible for gross bleeding in more than 50 per cent of our cases. Infants and children are more likely to bleed from the rectum than to vomit blood. In 19 cases the source of hemorrhage was not found. Meckel's diverticulum and intussusception were responsible for 17 cases each, while varices of the esophagus, duodenal ulcer, leukemia, mesenteric lymphadenitis, volvulus and regional enteritis acted as the cause of bleeding in a smaller proportion. The remaining cases were due to a variety of lesions (Table I).